Physical activity and body mass shape quality of life trajectories in mid-age women

To determine the combined longitudinal effect of body mass index (BMI) and physical activity (PA) on health-related quality of life (HrQoL), using the SF-6D (SF-36) utility measure.Five waves of self-reported data from the 1946-51 cohort (n=5,200; data collection, 2001-2013) of the Australian Longitudinal Study on Women's Health were used. Mixed effect models were employed to address the objective.Women with high PA experienced higher HrQoL regardless of BMI group, however, for those healthy or overweight, there was a very small decline in HrQoL over time. Women reporting no PA levels experienced the lowest baseline mean SF-6D score within each BMI group, with decreasing trajectories over the follow-up period. The rate of decline was greatest in women with obesity. Within each BMI group, there was a large, increasing gap in HrQoL between those who reported no and low PA over time. Women with obesity and high PA experienced similar HrQoL trajectories to women with normal weight or overweight with low PA levels. Overweight women with moderate PA experienced similar HrQoL to those with low PA but normal weight.PA may mitigate the adverse effect of overweight and obesity on HrQoL at mid-life, at higher activity levels. Implications for public health: PA benefits HrQoL regardless of body mass, with larger gains for those currently not physically active. Moderate to high PA may mitigate the effect of overweight and obesity

A framework for transition to specialty practice programmes

AIM: To develop a framework for emergency nursing transition to specialty practice programmes. BACKGROUND: Transition to Specialty Practice programmes were introduced to fill workforce shortages and facilitate the transition of nurses to specialty nursing practice. These programmes are recognized as an essential preparation for emergency nurses. Emergency nursing Transition to Specialty Practice programmes have developed in an ad hoc manner and as a result, programme characteristics vary. Variability in programme characteristics may result in inconsistent preparation of emergency nurses. DESIGN: Donabedian's Structure-Process-Outcome model was used to integrate results of an Australian study of emergency nursing Transition to Specialty Practice programmes with key education, nursing practice and safety and quality standards to develop the Transition to Specialty Practice (Emergency Nursing) Framework. METHODS: An explanatory sequential design was used. Data were collected from 118 emergency departments over 10 months in 2013 using surveys. Thirteen interviews were also conducted. Comparisons were made using Mann-Whitney U, Kruskal-Wallis and Chi-square tests. Qualitative data were analysed using content analysis. RESULTS: Transition to Specialty Practice programmes were offered in 80 (72·1%) emergency departments surveyed, to improve safe delivery of patient care. Better professional development outcomes were achieved in emergency departments which employed participants in small groups (Median = 4 participants) and offered programmes of 6 months duration. Written assessments were significantly associated with articulation to postgraduate study (Chi-square Fisher's exact P = <0·001). CONCLUSION: The Transition to Specialty Practice (Emergency Nursing) Framework has been developed based on best available evidence to enable a standardized approach to the preparation of novice emergency nurses

Which women stop smoking during pregnancy and the effect on breastfeeding duration

BACKGROUND: Cigarette smoking during pregnancy increases the risk of adverse pregnancy outcomes and women who quit smoking at this time are able to reduce the risk of low birth weight, preterm labour, spontaneous abortion and perinatal death. This study investigates the socio-demographic characteristics of pregnant women who stop smoking during pregnancy and the association between stopping smoking and breastfeeding duration. METHODS: A 12 month longitudinal study was conducted in two public maternity hospitals in Perth, Australia between mid-September 2002 and mid-July 2003. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. RESULTS: A total of 587 (55%) mothers participated in the study. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Women who were pregnant for the first time were twice as likely (OR = 2.05; 95% CI 1.047 – 4.03; p < 0.05) to quit smoking as multiparous women. Women who smoked more than 10 cigarettes per day were significantly less likely to quit smoking during pregnancy (OR = 0.36; 95% CI 0.18 – 0.69; p < 0.05). Women who consumed alcohol before pregnancy were three times more likely to quit smoking (OR = 2.58; 95% CI 1.00 – 6.66; p < 0.05). Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70; 95% CI 1.55 – 8.83; p < 0.05). CONCLUSION: Pregnancy is a time when many women are motivated to quit smoking and providing targeted smoking cessation interventions at this time, which take into account factors predictive of quitting smoking, are more likely to be successful

Use of information and communication technologies to support effective work practice innovation in the health sector: a multi-site study

<p>Abstract</p> <p>Background</p> <p>Widespread adoption of information and communication technologies (ICT) is a key strategy to meet the challenges facing health systems internationally of increasing demands, rising costs, limited resources and workforce shortages. Despite the rapid increase in ICT investment, uptake and acceptance has been slow and the benefits fewer than expected. Absent from the research literature has been a multi-site investigation of how ICT can support and drive innovative work practice. This Australian-based project will assess the factors that allow health service organisations to harness ICT, and the extent to which such systems drive the creation of new sustainable models of service delivery which increase capacity and provide rapid, safe, effective, affordable and sustainable health care.</p> <p>Design</p> <p>A multi-method approach will measure current ICT impact on workforce practices and develop and test new models of ICT use which support innovations in work practice. The research will focus on three large-scale commercial ICT systems being adopted in Australia and other countries: computerised ordering systems, ambulatory electronic medical record systems, and emergency medicine information systems. We will measure and analyse each system's role in supporting five key attributes of work practice innovation: changes in professionals' roles and responsibilities; integration of best practice into routine care; safe care practices; team-based care delivery; and active involvement of consumers in care.</p> <p>Discussion</p> <p>A socio-technical approach to the use of ICT will be adopted to examine and interpret the workforce and organisational complexities of the health sector. The project will also focus on ICT as a potentially <it>disruptive innovation </it>that challenges the way in which health care is delivered and consequently leads some health professionals to view it as a threat to traditional roles and responsibilities and a risk to existing models of care delivery. Such views have stifled debate as well as wider explorations of ICT's potential benefits, yet firm evidence of the effects of role changes on health service outcomes is limited. This project will provide important evidence about the role of ICT in supporting new models of care delivery across multiple healthcare organizations and about the ways in which innovative work practice change is diffused.</p

We should not be complacent about our population-based public health response to the first influenza pandemic of the 21st century

Background: More than a year after an influenza pandemic was declared in June 2009, the World Health Organization declared the pandemic to be over. Evaluations of the pandemic response are beginning to appear in the public domain. Discussion. We argue that, despite the enormous effort made to control the pandemic, it is now time to acknowledge that many of the population-based public health interventions may not have been well considered. Prior to the pandemic, there was limited scientific evidence to support border control measures. In particular no border screening measures would have detected prodromal or asymptomatic infections, and asymptomatic infections with pandemic influenza were common. School closures, when they were partial or of short duration, would not have interrupted spread of the virus in school-aged children, the group with the highest rate of infection worldwide. In most countries where they were available, neuraminidase inhibitors were not distributed quickly enough to have had an effect at the population level, although they will have benefited individuals, and prophylaxis within closed communities will have been effective. A pandemic specific vaccine will have protected the people who received it, although in most countries only a small minority was vaccinated, and often a small minority of those most at risk. The pandemic vaccine was generally not available early enough to have influenced the shape of the first pandemic wave and it is likely that any future pandemic vaccine manufactured using current technology will also be available too late, at least in one hemisphere. Summary. Border screening, school closure, widespread anti-viral prophylaxis and a pandemic-specific vaccine were unlikely to have been effective during a pandemic which was less severe than anticipated in the pandemic plans of many countries. These were cornerstones of the population-based public health response. Similar responses would be even less likely to be effective in a more severe pandemic. We agree with the recommendation from the World Health Organisation that pandemic preparedness plans need review

"Closing the gap" by 2030: Aspiration versus reality in Indigenous health

The goal of "closing the gap" in life expectancy between Indigenous and non-Indigenous people by 2030 is probably unattainable

Area-based differentials in childhood cancer incidence in Australia, 1996-2006

Background: International studies examining the association between the incidence of childhood cancer and characteristics of the area in which the patient lives have generally reported inconsistent patterns. Area-based differentials in childhood cancer throughout Australia have not been previously published at a national level. Procedure: Population-based information from the Australian Paediatric Cancer Registry was used to identify all children aged 0- to 14-years old diagnosed with invasive cancer or intracranial and intraspinal tumors of benign or uncertain behavior between 1996 and 2006. Age-standardized incidence rates per million children per year and the corresponding incidence rate ratios were calculated, categorized by remoteness of residence and an area-based index of socioeconomic disadvantage. Results were also stratified by the most common types of childhood cancer. Results: There was a significant, decreasing gradient in the incidence of childhood cancer as remoteness of residence increased. Children living in remote or very remote areas were 21% less likely to be diagnosed with cancer compared to children in major cities, mainly due to differences in the incidence of leukemias and lymphomas. This differential was no longer significant when only non-Indigenous children were considered. No clear relationship was found between incidence and socioeconomic status (SES) in contrast to similar earlier studies. Conclusions: The findings by remoteness of residence are consistent with the lower incidence rates of cancer that are typically associated with Indigenous Australians. There is also a suggestion that the etiological factors associated with childhood leukemia and SES may have altered over time

Aboriginal people in remote communities in Arnhem Land (Northern Territory) restrict their smoking in some environments: implications for developing and implementing interventions to reduce exposure to environmental tobacco smoke

Introduction and Aims: In Arnhem Land's remote Aboriginal communities [Northern Territory], very high smoking rates and overcrowding mean high exposure to Environmental Tobacco Smoke. This study compared smokers who restrict their smoking in these environments with those who do not. Design and Methods: In 2008–2009, 258 smokers (137 males and 121 females) aged ≥ 16 years, provided information permitting categorisation of those who 'RESTRICT' their smoking in the house, car or workplace from those who do 'NOT RESTRICT'. Univariable and multivariable logistic regressions compared 'RESTRICT' and 'NOT RESTRICT' groups by gender, age group, daily use, tobacco consumption, time-to-first-cigarette and quit intentions. Those in the 'RESTRICT' group explained their motivations, summarised using qualitative data analysis. Results: Men were almost twice as likely to 'NOT RESTRICT' their smoking (odds ratio = 1.88, 95% confidence interval = 1.14–3.08, P = 0.013). Time-to-first-cigarette was the strongest predictor to 'NOT RESTRICT' in women (odds ratio = 3.48, 95% confidence interval = 1.44–8.41, P = 0.006) with daily consumption the strongest predictor in men (odds ratio = 3.15, 95% confidence interval = 1.39–7.18, P = 0.006). Men and women shared similar motivations for restricting smoking. Discussion and Conclusions: Smoke-free homes and workplaces are important opportunities to reduce exposure to Environmental Tobacco Smoke in remote Indigenous communities